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A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65ml/min

Dukas, Laurent ; Schacht, Erich ; Mazor, Ze'ev ; Stähelin, Hannes

In: Osteoporosis International, 2005, vol. 16, no. 3, p. 332-338

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    Titre
    • A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65ml/min
    Auteur
    • Dukas, Laurent. Geriatric University Clinic, Kantonsspital, Ambulatorium Wiesendamm, Wiesendamm 22, 4057, Basel, Switzerland
    • Schacht, Erich. Metabolic Bone Disease Unit, Universitätsklinik Balgrist, Zurich, Switzerland
    • Mazor, Ze'ev. Bone Metabolism Unit, TEVA Pharmaceutical Industries, Jerusalem, Israel
    • Stähelin, Hannes. Geriatric University Clinic, Kantonsspital, 4031, Basel, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • Osteoporosis International, 2005, vol. 16, no. 3, p. 332-338. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:319818
    Summary
    Objectives: Because impaired renal function is detrimental for the conversion of calcidiol to calcitriol (D-hormone) and since D-hormone analogues have been shown to decrease the risk of falls, we investigated whether creatinine clearance (CrCl) is associated with the number of fallers and falls in elderly men and women. Methods: Within a randomized controlled study, we observed for 36weeks 186 placebo-treated community-dwelling elderly men and women over 70, in an attempt to determine the influence of baseline CrCl on calcitropic hormone serum levels, as well as the influence of baseline CrCl on the number of fallers and falls over time. With the help of questionnaires, we regularly assessed fall incidence and frequency. The risk of falls and the risk of becoming a faller were assessed in multivariate-controlled logistic regression models according to a cutoff value of the CrCl set at 65ml/min. Results: At baseline, serum levels of 1.25(OH)2D3 and iPTH were, in multivariate-controlled analyses, significantly associated with CrCl (p<0.0001, p=0.001, respectively), whereas serum levels of 25(OH)D3 were not associated with CrCl. Below a CrCl of 65ml/min, 1.25(OH)2D3 serum levels steadily declined. We therefore chose a CrCl of 65ml/min as cutoff for further analyses. During the 36weeks of observation, elderly people with a CrCl of <65ml/min had, in multivariate controlled analyses, compared with elderly with a CrCl of ≥65ml/min, a significantly higher incidence of number of fallers (25/70 vs 21/116; OR=4.01; 95% CI, 1.48-10.98; p=0.006), and a significantly higher incidence of falls (28/70 vs 23/116; OR=3.68; 95% CI, 1.38-9.82; p=0.009). Conclusions: For the first time we showed that in a community-dwelling population of elderly men and women, a CrCl of less than 65ml/min is a significant and independent risk factor for fallers and falls